What Is Universal Healthcare Coverage?

What Is Universal Healthcare Coverage?

Let me explain what universal healthcare coverage really means—it's a system where every resident in a specific country or area has health insurance. Think back to Germany in the 1880s, when Chancellor Otto von Bismarck pushed through laws that guaranteed healthcare access; that was one of the earliest examples. Today, you'll find this in most industrialized countries like France, Switzerland, and the United Kingdom, but not in the United States.

Even though the US spends more on healthcare than any other industrialized nation, it delivers worse health outcomes and covers a smaller portion of its population. Right now, the system is under even more pressure from the global pandemic, plus the revenue losses from paused elective surgeries and routine care.

Why Consider Universal Coverage Now?

People from New York City Mayor Bill de Blasio to the World Health Organization and even Pope Francis are pushing for universal healthcare in America as a solution to this mess. You can see why—the current setup is failing, and something has to change.

Understanding Universal Healthcare Coverage

There are at least three main ways to make sure everyone in an area gets covered for medical and hospital care. You could require or mandate health insurance, provide insurance through a single government payer without controlling the care itself, or go full socialized medicine where the government manages both insurance and the actual medical services.

Types of Universal Healthcare Coverage

First, there's required health insurance. Here, governments make it mandatory for all residents to buy a policy, or they hit you with a fine or penalty. The government might subsidize premiums, but most insurance comes from private companies. Take Germany— they've got both for-profit and not-for-profit insurers, and this approach has led to universal coverage in places like Germany, the Netherlands, and Switzerland.

In the US, the 2010 Affordable Care Act set up something similar with its individual mandate, which taxed people without insurance. But the Tax Cuts and Jobs Act killed that penalty starting in 2019. Still, some states like California, Massachusetts, New Jersey, Rhode Island, Vermont, and the District of Columbia have their own penalties. Massachusetts has been doing this since 2006, pushing insurance rates up to 95.4%.

Next up is single-payer insurance systems. In these, the government pays all health costs using tax money, which lets them negotiate better prices and control costs. Insurance is universal from one entity, but doctors and hospitals stay private. Canada and France are good examples—private insurers exist there but mostly for extra coverage.

Then there are national health care systems, where the government provides both insurance and medical care. The UK's National Health Service owns most hospitals and employs the providers. Sweden's system is publicly funded and mostly uses government providers, with private ones in a small role. These socialized setups are rarer than single-payer ones.

Important Note on the Current Crisis

The global pandemic has ramped up the strain on America's complicated and costly healthcare system, making it more critical to cut costs and maybe move toward universal coverage.

Special Considerations for the US

In the US, the ACA did boost the number of insured people, but we're nowhere near universal coverage. According to the US Department of Health, 8% of adults were uninsured in 2022, with the rest covered by a blend of government and private options.

For employer-based insurance, big companies often mix private and self-insurance to handle employee health costs. Since 2011, the federal government has encouraged private insurers to compete with programs like Medicare by offering lower costs and better benefits—some Medicare Advantage plans are standout examples. Medicaid recipients pick private plans that states and the feds largely fund.

This mixed approach can spark competition and innovation, giving you choices and reasons to keep costs down. But it creates an expensive system that doesn't deliver universal care and lags on public health metrics. Expect these topics to dominate party platforms and the 2024 presidential race.